Prophylaxis

• Nasogastric enteral nutrition (nasojejunal and parenteral feeding has also been shown to reduce the incidence of stress ulcer bleeding)

• Adequate tissue perfusion (flow and pressure)

• The role of prophylactic drug therapy including H2 antagonists, proton pump inhibitors and sucralfate is controversial. Evidence suggests that enteral nutrition alone is as effective and there are claims that loss of the acid environment in the stomach predisposes the patient to nosocomial infection. Patients at highest risk are those requiring prolonged mechanical ventilation or with a concurrent coagulopathy.